Premium credits will be applied to fully-insured employer groups (except flex-funded) with medical, dental and/or vision plans, Medicare Supplement medical, dental and/or vision plan subscribers, and IFP dental plan and/or vision plan subscribers.
Why isn’t Blue Shield providing premium credits to all lines of business or members?
We are issuing premium credits to each market segment permitted by state regulators and Covered California.
Why are premium credits applied to IFP dental plan and/or vision plan members only?
We are issuing premium credits to each market segment permitted by state regulators and Covered California.
Can members or employer groups request a premium credit if they do not receive them automatically?
No. The Premium Credit Program is applied to eligible subscribers and employer groups only, as determined by the program parameters outlined in this web page.
Can members or employer groups request a premium credit if they feel the amount credited is incorrect, or insufficient?
The Premium Credit Program is applied using the same percentages for all eligible customers and market segments. If customers feel the credit is incorrect, they may follow the standard grievances process.
Does the premium credit apply to self-funded plans?
No.
Are premium credits applied only to customers whose accounts are delinquent or in a grace period?
No. All customers in the eligible market segments will receive a credit, regardless of their account billing status.
Do employer groups need to disperse the credit to their employees/group members?
Blue Shield is not a financial institution or tax advisor. We cannot provide legal, tax, or financial advice. Group administrators should contact their legal, tax, or financial advisors.
Are other Blues plans taking this action?
Blue Shield of California is implementing the Premium Credit Program independently.
The following questions/answers are specific to Large group / Premier group / custom accounts.
Does the premium credit apply to flex-funded plans?
No. Flex-funded accounts are out of scope for this program.
Does the premium credit apply to GMAPD members?
Not at this time.
Will mix-funded employer groups receive a premium credit?
Yes. Mix-funded groups will receive premium credits for their fully-insured products.
How will this impact groups that were already given premium credits during renewal and/or as part of the negotiation?
The credit is for existing groups (including new groups enrolled effective 10/1/20), even those who received a premium credit previously. The program is not considered, presented, or provided as part of any renewal offering.
How will this program be implemented for fully-insured cases that self-bill? How will credit amounts be determined, and which month will it apply to?
The credit will be applied to their November bill and calculated based on the customer’s October premium. Consistent with all other employer groups included in this program an approximately 10% credit on medical plans and approximately 30% credit on dental and/or vision plans will be applied to their November bill accordingly.
When calculating the Premium Credit, were pass-throughs included?
No. The premium credit was calculated based on the actual premium amount. No pass-throughs were included in the credit calculation.
Does the Premium Credit Program include value-added services or buy-up options in calculating the credit amount?
No.
Does the Premium Credit apply to Stop Loss Coverage?
No.
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